重症新型布尼亚病毒感染的临床特征和疗效分析

Clinical characteristics and treatment efficacy of sever infection caused by new bunyaviridae

目的探讨新型尼亚病毒感染所致的重症发热伴血小板减少综合征(SFTS)患者的临床特点、预后以及影响病死率的相关因素。方法收集2014年8月至2019年9月南京中医药大学附属南京医院重症医学科收治的23例SFTS患者的临床资料,包括流行病学资料,症状及体征,辅助检查结果等。按照患者转归将患者分为两组:存活组(15例)和死亡组(8例)。比较两组流行病学资料、症状及体征、实验室检测指标等差异。结果23例患者均有发热、乏力,恶心呕吐14例,咳嗽咳痰12例,腹泻16例,出血12例。出现神经系统改变的14例,14例患者全部存在不同程度的意识障碍及球结膜水肿,其中4例出现言语模糊不清,3例患者出现全身或部分肢体抽搐,2例患者病理征阳性。8例患者死亡,15例患者好转出院或者转普通病房治疗。比较死亡组与存活组患者的临床资料和实验室检查结果,发现死亡组患者出现神经症状比例高于存活组患者(P<0.05)。死亡组较存活组患者病毒载量更高、脑钠肽平均值更高,差异有统计学意义(P<0.05)。死亡患者年龄[(52.41±12.64)岁]高于存活组[(40.16±19.59)岁](P<0.05)。结论SFTS患者的病死率高,高龄、出现神经症状、心功能差是预后的重要预测指标。病毒载量可以有效监测疾病的严重程度,预测预后。

Objective To summarize the clinical characteristics,prognosis and related factors affecting mortality of severe SFTS patients caused by new bunyaviridae.Methods Clinical data of 23 SFTS patients admitted to the Department of Critical Care Medicine of our hospital from August 2014 to September 2019 were collected,including epidemiological data,symptoms,signs,and the results of auxiliary examinations.According to the outcome of patients,patients were divided into two groups:survival group and death group.The differences of epidemiological data,symptoms,signs,and laboratory test indexes between the two groups were compared.Results All patients had fever,23 cases had poor appetite,14 cases had nausea and vomiting,12 cases had cough and sputum,16 cases had diarrhea and 12 cases had hemorrhage.There were 14 cases of nervous system changes,14 cases had different degrees of consciousness disorder and bulbar conjunctival edema,4 cases had blurred speech,3 cases had convulsions of whole body or part of limbs,and 2 cases had positive pathological features.Eight patients died and 15 patients were discharged from hospital or transferred in the general ward for treatment.Comparing the clinical data and laboratory examinations of patients in death group and survival group,it was found that the proportion of neurological symptoms in patients that died was significantly higher than that in patients that survived(P<0.05).The viral load of the dead patients was higher and the average BNP was higher than that of the survived patients(P<0.05).The average age of the dead patients was older than that of the improved patients(P<0.05).Conclusion The mortality rate of severe SFTS patients is high.Age,neurological symptoms,poor cardiac function and poor coagulation function are important prognostic indicators.Viral load can effectively monitor the severity of the disease and predict the prognosis.